Fig 3.

Classic 2-portal endoscopic approach. The patient is in the prone position, and the right foot is exposed. (A) Creation of posterolateral portal at level of tip of lateral malleolus, just lateral to Achilles tendon. Following the initial 0.5-cm skin incision, a mosquito clamp is used to split the subcutaneous tissue in a way that prevents injury to the adjacent sural nerve branches. The clamp should be directed toward the interdigital space between the first 2 toes. The bone surface is palpated with the tip of the clamp, which is subsequently removed and replaced by the scope obturator in the same direction. (B, C) The posteromedial portal is created at the mid distance between the medial malleolus and the Achilles tendon border. Following the skin incision, a mosquito clamp is introduced and directed toward the obturator and forward to the Achilles tendon. When the mosquito clamp touches the shaft of the obturator, it has to be opened to create a space at the posterior aspect of the talus that is needed for the outflow.